Case reportRecurrent hemarthrosis following total knee arthroplasty. Report of a case treated with arterial embolization
Section snippets
Case report
A 79-year-old man was admitted in January 2001 for hemarthrosis in the right knee. A three-compartment cemented knee prosthesis had been implanted on the same side in 1994 for osteoarthritis complicating genu varum deformity. The postoperative course had been uneventful. In December 1999, the patient fell and fractured his left patella. He was on antiplatelet therapy with low-dose aspirin (250 mg/d). Conservative orthopedic treatment of the fracture was successful. Two months later, he
Discussion
The incidence of hemarthrosis after total knee arthroplasty has been estimated at 0.5% [4]. The time from arthroplasty to hemarthrosis has ranged from 2 to 12 years. In most patients, the prosthesis was cemented and the underlying disease was osteoarthritis, rheumatoid arthritis, or osteonecrosis. The mean number of recurrences was 5.5 (range, 1–20). The interval between episodes ranged from a few days to 1 year. Ten patients had been taking drugs known to increase the risk of bleeding (oral
Conclusion
Recurrent hemarthrosis following knee arthroplasty is extremely uncommon. The treatment is not standardized. In less than half the cases, a cause is found after synovectomy, which is effective in patients who fail to respond to conservative treatment. Vascular causes are exceedingly rare and dominated by aneurysms. We report a case related to simple hypervascularization of the joint. Selective embolization was effective.
References (8)
- et al.
Recurrent hemarthrosis after total knee arthroplasty
J Arthroplasty
(1995) - et al.
Recurrent hemarthrosis following a total knee arthroplasty
J Arthroplasty
(1995) - et al.
Recurrent hemarthrosis after total knee arthroplasty
J Arthroplasty
(1996) - et al.
Periarticular aneurysm formation in haemophilia
Lancet
(1997)
Cited by (26)
Technically Successful Geniculate Artery Embolization Does Not Equate Clinical Success for Treatment of Recurrent Knee Hemarthrosis after Knee Surgery
2016, Journal of Vascular and Interventional RadiologyGeniculate artery embolization for recurrent postarthroplasty hemarthrosis of the knee
2015, Radiology Case ReportsCitation Excerpt :Spontaneous hemarthrosis of the joint is rather common and seen frequently in people with history of a bleeding disorder like hemophilia (5); however, recurrent spontaneous hemarthrosis of the knee following TKA is uncommon (1–4). Interestingly, reported etiologies of late recurrent hemarthrosis in patients without an underlying bleeding disorder are very diverse: pseudoaneurysm (6–7), prolonged anticoagulant therapy (8), hypertrophy of geniculate arteries (9–10 and 16–17), intra-articular fasciitis (11), meniscal ganglion cyst (12), epithelioid angiosarcoma of bone (13), metal particle in synovial fluid (14), and arteriovenous fistula (15). Our case is another report attributing recurrent hemarthrosis following TKA to hypervascularity of the geniculate arteries.
A case of selective arterial embolization for recurrent hemarthrosis after total knee arthroplasty
2013, Journal of Orthopaedic ScienceTransarterial embolization for the management of hemarthrosis of the knee
2012, European Journal of RadiologyCitation Excerpt :Several authors have reported on TAE in patients presenting with hemarthrosis of the knee. However these studies included only small patient populations [1,4,6,8–10]. The purpose of the present retrospective study was to evaluate TAE for the management of hemarthrosis of the knee in a larger population including 34 patients treated at two different hospitals.
Embolisation for vascular injuries complicating elective orthopaedic surgery
2011, European Journal of Vascular and Endovascular SurgeryCitation Excerpt :The risk after revision-knee arthroplasty is twice as high because of encasement of the poplitaeal vessels by dense scar tissue in the poplitaeal fossa.2 The incidence of vascular injuries in spinal surgery has been <0.05%,6,7,9 most commonly associated with L4–L5 lumbar discectomy.6,9,37 In the present series, vascular injuries were more common in hip compared with knee arthroplasty.